The Various Strains of Adaptation: Applications From State-Level Efforts to Implement Evidence-Based Practices in Washington State

While evidence-based practice in mental and behavioral health continues to garner increasing policy and empirical support, uptake among practitioners remains low (Morrison, Bradley & Western, 2003). Several common challenges exist within multiple service sectors that work against the wide availability of empirically-supported mental health treatments in community-settings (Fixsen, Blase, Naoom, & Wallace, 2009). One of these challenges is that a fundamental value within social work and psychology is the tailoring of practices to the unique needs and diversity of family systems and individual cases (Spring, 2007). Consequently, to the degree that empirically-supported treatments are seen as rigid, inflexible and “one size fits all” approaches to treatment, there is pushback and reluctance to adopt or even seriously investigate these programs. As a result, the adaptation of programs, both formally with developers and informally as ad hoc adjustments by providers, is a reality of real-world implementation (Rhoades, Bumbarger & Moore, 2012).  At the same time, while an extensive literature supports the assertion that cultural considerations are critical in the engagement and treatment success of clients (Wade & Berstein, 1991; Yutrzenka, B.A., 1995; Sue, 2003), research also suggests that un-adapted empirically supported treatments are at least promising and are often effective with minority groups (Wilson, Lipsey & Soydan, 2003). Indeed, researchers are finding that the engagement benefits of adaptation may be its most salient feature. Lau (2006) identified improved engagement, or social validity, as a significant benefit of evidence-based program adaptation.  

This presentation will describe the framework for various adaptation approaches we are using to guide EBP implementation efforts in Washington State. Our division within the University of Washington, School of Medicine, is the identified lead for technical assistance related to recent legislation mandating the use of EBPs for child-serving services. This technical assistance includes, among other activities, developing strategies for culturally competent program implementation. The framework we developed uses a three-pronged approach for identifying adaptation needs that synthesizes the literature in this area. The first level involves a culturally competent approach to informing communities about EBPs and using culturally-aligned strategies to recruit clients into programs. The second level involves surface level adjustments to programs to enhance cultural relevance (e.g., use of culturally appropriate metaphors). The third level involves adjustment to core program components which are deemed necessary to appropriately address developmental or site of delivery differences in the target population (e.g., adaptations for age or from office-based to school-based care). Examples from past and current projects will be explored including a community engagement approach involving 16 Native American tribes across Washington State, an adaptation of a treatment focused on reducing juvenile recidivism with Latino families, and an adaptation of a cognitive-behavioral group treatment program for violence and offending reduction for girls.